Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of ...atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio OR 5.05, 95% confidence interval CI 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay.
A 67-year-old female with prior medical history of HTN and asthma presented with acute-onset dyspnea and nausea for 4 days prior to admission. Upon initial encounter in the emergency room, she was ...found to have findings of abnormal pulmonary infiltrates and consequent workup revealed COVID-19. During further hospital course, the patient developed abnormal EKG and echocardiographic findings consistent with stress-induced cardiomyopathy.
Purpose of Review
Current ablation approach for arrhythmias relies upon the use of radiofrequency (RF) and cryoablation catheters. Although there have been significant advances both in catheter ...design and in energy delivery approaches, limitations such as suboptimal efficacy and safety remain. Pulsed field ablation (PFA) has emerged as a novel approach to ablation that is distinct from RF and cryoablation by virtue of selective ablation of myocardial tissue. Preclinical and clinical reports have demonstrated lesion durability with an excellent safety profile. These findings need to be confirmed in prospective randomized trials that are currently ongoing. In this review, we describe efficacy and safety outcomes from both pre-clinical and clinical studies that have been performed so far and briefly discuss ongoing clinical trials and future investigations.
Recent Findings
Data from pre-clinical and clinical research have shown PFA as a promising tool for ablation of cardiac arrhythmias. In addition to safety regarding mitigating the risk to surrounding structures such as the phrenic nerve, esophagus, PFA also offers an effective method for ablation.
Summary
In this review, we summarize the currently published pre-clinical and clinical data evaluating the safety and efficacy of PFA for cardiac arrhythmias.
Abstract Background Catheter ablation has emerged as a widely used treatment modality for atrial fibrillation (AF). P-wave abnormalities have been described in the patients with AF, and catheter ...ablation may potentially further impact P-wave parameters due to ablation of atrial tissue. Methods We reviewed data on P-wave parameters (P-wave duration, amplitude and P-wave duration and amplitude product) in leads V1 and aVF and changes in the P-terminal force (Ptf; product of duration and amplitude of terminal part of P-wave) in lead V1 from 12-lead electrocardiograms obtained prior to and after CA of a total of 46 (28 paroxysmal and 18 persistent) AF patients. Results The median age of patients in our study was 63 (range: 30–77) years. We noticed a significant reduction in the P-wave duration (from 87.39 ± 28.62 ms at baseline to 72.09 ± 24.59 ms; p = 0.0072) and the product of P-wave duration and amplitude in lead V1 (12.16 ± 5.54 mV ms at baseline to 8.30 ± 5.78 mV ms, p = 0.0015) after CA. There was also a significant decrease in P-wave duration (from 92.57 ± 19.67 ms at baseline to 76.48 ± 16.32 ms after CA, p = 0.0001) and P-wave duration and amplitude product in lead aVF (12.61 ± 4.05 mV ms at baseline to 9.77 ± 3.86 m V ms after CA, p = 0.0001). CA also led to a significant decrease in Ptf (from 4.56 ± 1.88 at baseline to 2.85 ± 1.42 mV ms, p < 0.0001). Conclusion Radiofrequency catheter ablation of AF leads to modification of P-wave parameters with substantial diminution in both the amplitude and duration of the P-wave in leads V1 and aVF. This likely represents reduction in electrically active atrial tissue after ablation, and may serve as a marker for the extent of ablated atrial tissue.
Echocardiographic left atrial (LA) strain parameters have been associated with atrial fibrillation (AF) in prior studies. Our goal was to determine if strain measures peak systolic longitudinal ...strain (LAS) and stiffness index (LASt) changed after cardioversion (CV); and their relation to AF recurrence.
46 participants with persistent AF and 41 age-matched participants with no AF were recruited. LAS and LASt were measured before and immediately after CV using 2D speckle tracking imaging (2DSI). Maintenance of sinus rhythm was assessed over a 6-month follow up. Mean LAS was lower, and mean LASt higher, in participants with AF before CV as compared to control group (11.9±1.0 vs 35.7±1.7, p<0.01 and 1.31±0.17 vs 0.23±0.01, p<0.01, respectively). There was an increase in the mean LAS immediately after CV (11.9±1.0 vs 15.9±1.3, p<0.01), whereas mean LASt did not change significantly after CV (p=0.62). Although neither LAS nor LASt were independently associated with AF recurrence during the follow-up period, change in LAS after cardioversion (post-CV LAS-pre-CV LAS) was significantly higher among individuals who remained in sinus rhythm when compared to individuals with recurrent AF (3.6±1.1 vs 0.4±0.8, p=0.02).
LAS and LASt differed between participants with and without AF, irrespective of the rhythm at the time of echocardiographic assessment. Baseline LAS and LASt were not associated with AF recurrence. However, change in LAS after CV may be a useful predictor of recurrent arrhythmia.
Methods: We reviewed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample (NEDS) databases from 2006-2013 for ER visits with a primary complaint of chest pain ...(ICD-9-CM codes 786.50, 786.51 and 786.59).
Our knowledge of associated cardiotoxicities from novel therapeutics in oncology continues to expand. These include arrhythmias from cancer-therapy induced cardiomyopathy resulting from both direct ...and indirect effects on cardiomyocytes and other mechanisms that can adversely impact cardiovascular outcomes and overall mortality. In this review, we focus on both the arrhythmias of various classes of oncologic agents as well as the use of cardiac implantable electronic devices (cardioverter-defibrillators, permanent pacemakers, and cardiac resynchronization therapy) in cardio-oncology patients.
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Introduction:
Left atrial appendage closure (LAAC) has evolved as a non-pharmacological alternative for stroke prevention in patients with Atrial fibrillation (AF). The occurrence of ...post-operative AF is well described after cardiac and percutaneous procedures. But, there is limited understanding of the possibility of new-onset AF as a result of LAAC.
Aims:
To investigate the incidence of, and factors associated with, AF after LAAC.
Methods:
We conducted a retrospective analysis of 121 patients with i) paroxysmal AF, 2) had undergone LAAC, and 3) had an implantable electronic devices (CIEDs): pacemaker, defibrillator or implantable loop recorder. Patients with persistent AF and those presenting in AF on the day of LAAC were excluded. Data were collected on baseline characteristics, Colchicine use, antiarrhythmic drugs and prior history of AF ablation. Remote transmissions and device interrogations were analyzed to ascertain new-onset AF during the 6 months follow up period after LAAC. Univariate and multivariable analyses were performed to analyze factors associated with the occurrence of AF after LAAC.
Results:
Of the total 121 patients, 39 (32.2%) developed AF during the 6 month follow up period after LAAC. On univariate analysis, a lower CHA2DS2-Vasc score was associated with a lower incidence of AF post LAAC (OR 0.74, 95% CI 0.55-0.98, p = 0.04). On multivariable analysis, including variables of age, gender, CHA2DS2-Vasc score, use of Colchicine and history of AF Ablation, we observed a statistical trend towards the protective effect of prior AF ablation on occurrence of AF after LAAC (adjusted OR 0.32, 95% CI 0.10-1.05, p =0.06). There was also a statistical trend towards the protective effect of Colchicine on occurrence of AF after LAAC (adjusted OR 0.15, 95% CI 0.02-1.29, p =0.08).
Conclusions:
In our study of paroxysmal AF patients undergoing LAAC, who presented in sinus rhythm on the day of the procedure, the incidence of CIED detected post-procedural AF was 32.2%. We observed statistical trends towards protective effects of prior AF Ablation and use of Colchicine during the peri-LAAC period on occurrence of AF after LAAC.
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Introduction:
The current USPSTF guidelines recommend use of aspirin for primary prevention of CAD in adults aged between 50-69 years. In our study, we sought to determine the ...association of household income and socioeconomic factors and the use of aspirin for the primary prevention of CAD in the eligible population.
Methods:
After excluding the participants with prior diagnosis of CAD, those who had a condition which would make the use of aspirin unsafe and missing data on household income, we analyzed a total of 3,913 participants from the Behavioral Risk Factor Surveillance System 2015 database for our study. We performed univariate comparison of various covariates in two categories of participants based on an income threshold of 50,000$. Subsequently, we performed logistic regression and stepwise modeling approach for multivariable analyses to assess the association between the use of aspirin (outcome) and various covariates.
Results:
In an unadjusted logistic regression model, the participants with household income < $15,000 were 67% less likely to use aspirin (OR: 0.33, 95% CI: 0.23-0.47, p< 0.0001) in comparison with the reference group of > $50,000 household income. After adjusting for race, education, insurance, gender, household size and cholesterol awareness in our fully adjusted model, we observed that the participants with household income of $35,000 to $50,000 were 53% less likely to take aspirin for prevention of CAD as compared to referent group of income > 50,000$ (adjusted OR: 0.47, 95% CI: 0.28-0.76, p = 0.003). The participants of Hispanic race were also about 43% less likely to take aspirin as compared to Caucasians (adjusted OR: 0.57, 95% CI: 0.40-0.80, p = 0.002).
Conclusions:
Our findings highlight significant disparities in the use of aspirin for primary prevention of CAD potentially reflecting the role of income and racial factors. A targeted approach to address the use of aspirin in these subgroups might be beneficial.
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